Feburic, gout and protein powder questions

[Sandeep]

This is going to be a long post. So please bear with me.

I am a 29 year old male from India. I have recently been diagnosed with elevated uric acid levels in my body.

I am an eggitarian(eat about 2 eggs per week) and I take protein supplement everyday(1 serving of Protinex – about 9g of protein per day) and it is SoyProtein. I doubled my protein intake for 3 months last year(about 24g of protein per day) because I felt weak and I had protein deficiency previously. In early January 2017 I noticed pain in my toes during the night when I tried to sleep. I noticed that everytime I had an omlett afterwards the pain seemed to return. And it started happening more frequently later on. On the pain scale I would say a pain of about 6 for 10 mins. Usually it went away on it’s own after sometime. But since the frequency increased I knew that my excessive Protein intake might be a culprit and I visited a doctor on Feb 20th, 2017 and the Uric acid blood test showed 7 mg/dl. I was told that my Uric acid levels are higher than normal and I have to take medication for that. I was put on feburic 40 mg for 6 weeks. I asked my doctor if I can continue taking Protein supplement and he said that it could be taken without any issues. Now I reduced my dosage 6-7g of Protein per day. And on April 1st,2017 I had my second Uric Acid test and the result showed 4.0 mg/dl. I was happy with the Uric Acid level reduced to an extent but my doctor said that I have to continue for another 2 months and he was anticipating my Uric Acid to be less than 2.0 mg/dl with the dosage prescribed. However I had a lot of issues when I was taking the feburic 40 mg medication – suffered from sleeplessness throughout my dosage and initially for the first week I suffered shortness of breath as well. Because of these effects I wasn’t able to concentrate on work and had to stay home for 3 weeks. I have a few questions on the Uric Acid level.

What is the protein supplement I can take despite having the problem with Uric Acid levels? I researched in google and it said SoyProtein does not exacerbate the pains but in my case I guess it’s not being digested properly. I live in India and very few protein supplements are available here. Is it Ok to consume Whey Protein instead of Soy Protein.

Now that Uric Acid Levels are 4.0 does that mean that the Uric acid crystals have dissolved completely? I still get mild pain time and again. Also please tell me if I can continue taking egg in my diet. I will have to restrict peas, legumes and lentils as far as I know. Please let me know if I to stay away from anything else.

How to get rid of sleeplessness that is caused by the Feburic medicine? My doctor prescribed NitRest, maybe a sleeping pill with a bit of anti-anxiety as well but I had problems with panic attacks and anxiety in the past and the medicines did not help. So I didnt want to take them.

Google says that an average person might need to consume proteins(in grams) equivalent to their body weight(in Kgs). Like I explained before I consumed excessive protein for maybe 3 months. I never consumed more than 30g of protein per day even in those days? But I think that those 3 months have elevated my uric acid levels significantly.

Are there any natural remedies available for getting rid of excessive uric acid in the body? I heard about Lemon juice and Apple cider vinegar. In India we get Apple Cider Vinegar in packaged bottles and I am doubtful of the effect of this processed food.

Thanks.

[nobody]

If two eggs a week is all the animal food you eat, it may not be sufficient for you to look at your total protein intake. For all I know, you might need specific proteins from soy.
I also don’t understand how you could eat so little protein to begin with. Are you only counting supplements?
If you are practically vegan, surely you need soy, lentils, peas and such and shouldn’t restrict your consumption too much because you’re afraid of purines. It’s not even clear such foods are a major factor in determining how much uric acid there is in your blood.

Has your blood been tested for uric acid only twice? If you have more test results, please consider posting them as well (Keith might be able to make use of them). I’m no expert but 7 is not very high and “a pain of about 6 for 10 mins” doesn’t sound like typical gout symptoms to me.
Besides protein, eggs contain a type of fat your body may not be used to and the metabolism of fat seems to play a role in inflammation. Whether or not you have gout, I would not rush to blame your symptoms on protein. And if you have gout, you don’t need to stop eating eggs.

Finally, about the side effects of feburic: this may seem obvious but you could try taking the pill at a different time during the day.
There are also other drugs people use to lower their uric acid levels which may or may not be suitable for you.

[Sandeep]

Hello,

Thank you for your reply.

Regarding my protein intake, these days I am not even having protein intake of 2 eggs a week. When I said I was taking 24g of Protein per day, it was through supplements alone. I consume peanuts almost every day in some form and once or twice a week beans and peas as well. Those are my other protein sources. Right now they are the only sources for protein in my body. I also take soaked 4 almonds every alternate day. That could be another minor protein source. As per some links in google, soy protein does indeed risk for gout.. please check

[pubmed/21859653] Messina, Mark, Virginia L. Messina, and Pauline Chan. “Soyfoods, hyperuricemia and gout: a review of the epidemiologic and clinical data.” Asia Pacific journal of clinical nutrition 20, no. 3 (2011): 347-358. Soyfoods, High Uric Acid, and Gout PDF.

Anyway, I want to know how people meet their protein requirements through supplements when they can’t have meat. Is whey protein or Casein good for gout? I found a casein protein supplement and I have decided that I take 2 per day at least to meet min protein requirement.

Casein Protein Powder for Gout

I saw the doctor for my uric acid levels only 45 days back. So yes I only have 2 Uric acid tests done
Feb 20, 2017 the Uric Acid level was 7.0 mg/dl
After feburic 40 mg(febuxostat), April 1,2017 Uric Acid level was 4.0 mg/dl

I asked my doctor if I could take my feburic after dinner. But he insisted that it has to be taken after breakfast. Because of the horrible sleeplessness that I had, I wasn’t able to attend my office and requested my doctor to see if I can stop my medication to see my uric acid levels in a month. So my next test would be in the first week of May.

I stopped taking the feburic 40 mg tablet 4 days back, my sleep has improved. But I feel these light stabbing sensations underneath my nails in fingers and toes during the night and also sometimes during the day as well.

This may seem unusual but when I first started getting my symptoms I also noticed that when I tried removing mucous from my nose I smelled bad. When I was taking the feburic medicine it almost stopped but since the 4 days I quit that again I notice this bad smell when I am getting rid of mucous.

I limited my consumption of purine rich foods now and this should eliminate the source of uric acid to an extent I hope. One more point worth mentioning is that I have been suffering with bad knees from 4.5 years now and it might have adversely affected my metabolism. I am already having plenty of trouble running from one Ortho to another to diagnose what exactly the issue is and now I have to tackle this as well 🙁

[nobody]

I have for many years eaten no meat, fish or seafood and I’ve never taken any protein supplement.
There is plenty of protein not only in lentils, beans and such but also in grains as as well as in other seeds. Even leafy vegetables contain protein. But sugar and oil do not.
Depending one one’s tastes and habits, it’s certainly possible to fail to eat enough protein but the challenge for adults eating no animal products but who can afford a reasonable diet and have no special needs is not so much to reach an adequate total protein intake but to eat enough of every type of protein. Soy seems to be helpful in that regard (as well as contributing nicely to one’s total protein intake).

From the abstract you linked to:
“none of the six epidemiologic studies identified provided any evidence that soy intake was associated with circulating uric acid levels”
and
“on the basis of the existing data there is no reason for individuals with gout or at risk of developing gout to avoid soyfoods”
Which is of course not to say that soy doesn’t make any difference but it certainly seems like it usually makes little difference when consumed in moderation.
As with many other foods, there is however a risk involved in eating too much of one thing, especially if you have a health problem such as gout. The risk is of course much greater when consuming extracts, powders and other supplements.

Did your doctor tell you why you should be taking Feburic at breakfast?
Others might be interested to know because that’s not what all doctors recommend.

It’s good that you are planning to monitor your uric acid in the future. It’s better to have the test too often than not enough.
And since you are experiencing a variety of symptoms, the next time you see your doctor you might also want to ask about the various drugs which only help with the symptoms. Trying such drugs when you are having different symptoms might help you and your doctor to determine if they are likely to be caused by the same thing.

[Keith Taylor]

Fundamentally, I’d say there is no need to worry about gout diet if you are successfully controlling uric acid with Feburic (febuxostat). But, there are two important considerations:
1. Your diet must remain healthy. There’s general healthy nutrition advice for India at https://www.nhp.gov.in/healthlyliving/healthy-nutrition
I haven’t researched this in detail. But, it looks better value than the so-called advice from someone trying to sell supplements. Are casein pills safe? Why not just drink milk for better uric acid control?
2. If you aim to reduce reliance on Feburic after dissolving most uric acid crystals, you will need specific help to get a better gout diet. Start with a personal gout diary. Then, ask about a personal gout diet plan.

Also, you might like to join the Meatless Protein and Gout discussion.

According to the Febuxostat label, there’s no restriction on time of day, or meals. But, it makes sense to take Feburic around the same time each day. More importantly, be sure to get liver function tests when you’re on febuxostat.

Which is your febuxostat (Feburic) dose?

[Andy (old forum)]

this is my gout experience.

I am 33 years old. I got a gout attack in Sept 2012, the uric acid was 11.5 at that time( first gout may be March of 2011, but I was not aware that it was a gout problem), I took Voltaflam during the pain, after 3 weeks, the pain was gone.  then I start taking Feburic 40 for 2 months and Uric acid dropped to 5.6.

From here, I learned that it’s better to keep uric acid below 5 to remove all uric acid crystal in your body, so I start taking Feburic 80 for 2 months, during that 2 months, the uric acid was keeping below 4,  I assume that crystal has been removed in my body, then I reduce from 80 to 40 and keep taking 40 for 1 month, from last week, I reduced to 20, and today I feel the pain came back on my toe( not very serious), I took a uric acid test today, the uric acid is 5.6.

I took only veg from Nov to Jan,  but start taking pork, beef mutton from Feb, and took whiskey 4 times from 9th Feb to 16 Feb( around half bottle each time)

Also, I took baking soda sometimes.

Why the pain came back while the uric acid level is low? if my uric acid crystal has been totally removed from my body?

[Keith Taylor]

Hi Andy,

“during that 2 months, the uric acid was keeping below 4, I assume that crystal has been removed in my body”

I think the problem is time. 2 months is not really long enough to get rid of old crystals. They grow very slowly, so if you noticed 2 years ago, they will have started long before that. Some dissolve quite quickly, but others are trapped behind dead white blood cells.

I always regard 6 months as the minimum time for getting rid of crystals. You did the right thing by increasing febuxostat, but I think you should have kept that going longer. Of course, there is always the chance that your recent pain is something other than gout, so if it persists, it’s better to get it checked.

[Andy (old forum)]

Thanks for your information, I am Chinese and I am staying in India now.

I took Voltaflam for last 2 days, the pain is reducing. it looks the pain will be totally resolved by tomorrow .

If my uric acid is below 7 without taking medicine, should I keep taking Feburic(febuxcostat)?

[Keith Taylor]

7 is not safe for anyone who has ever had gout. You are almost certain to end in a state where uric acid crystals dissolve and reform, sending continuous signals to your immune system. White blood cells attack crystals in both these states, and it is difficult to tell from the pain. Attacks during crystals dissolving tend to be more widespread, but this is not always the case.

The target for most gout sufferers is 5 mg/dL (0.30 mmol/L).

This might need to be relaxed to 6 if kidney problems or other health issues prevent attaining 5, but 5 gives the best safety margin for fluctuations in uric acid level, and in temperature.

It is always a good idea for the first six months to try to get down to 2 or 3. This dissolves existing crystals faster. Which reduces the period of time you are at risk from gout flares.

[Andy (old forum)]

I stopped taking Feburic for one week and took a test yesterday, the result is 7.6. I will start taking Feburic 80 for another 6 months to remove all crystals behind white blood cells. Thanks a lot for your professional advice.

[Keith Taylor]

Thanks, Andy – I need to make a couple of points:

1. 6 months may not be long enough. Keep careful records of uric acid levels and gout flares. Consider yourself safe when you have gone 6 months without a gout flare, and with uric acid at 5 or below. Get monthly tests for uric acid, kidney function, and liver function. Uric Acid Test frequency can be relaxed when results stabilize, but never less than once a year.

2. My advice is not professional. It is here to help you discuss gout with your own professional medical team, and is no substitute for visiting your doctor. There may well be circumstances in your medical history or family history that make my advice bad. I usually describe myself as a layman. A better word might be amateur – I do it for love, but it is vital that you discuss my advice with your doctor.

[Suyash]

Hi GoutPal ,
I am Suyash 32 years old , even I am suffering from gout arthritis level of uric acid was 13.8 which is now reduced to 7.2 but still there is pain in my right toe currently I am on 2 tabs of febustat 80mg . Can you suggest me proper Indian diet to reduce the uric acid levels and also exercise .
Thanking you

[Keith Taylor]

Hi Suyash

I refer you to the reply I gave Sandeep – https://goutpal.net/forums/topic/alternate-protein-sources-and-getting-rid-of-side-effects-of-feburic/#post-3097

Because my attitude to gout diet is:
1. First establish healthy eating patterns. So there’s a link to Indian government advice in my first reply.
2. Consider improvements to a basic healthy diet for better uric acid control. Now that means reviewing the weekly list of food you eat. So there’s not much more I can say without a list of what you eat now.

As for exercise, there are no specific gout exercises. Except to avoid stressing joints. Because your joints will be weakened by years of uric acid crystals.

Finally, for now, you need to get your doctor to review your febuxostat dose. Because 7.2 mg/dL is still too high – get under 5 unless there are medical reasons why you can’t.

[nobody]

Suyash should clarify but it sounds like they might be taking 160mg febuxostat a day. This is a huge dose which could well be unsafe (considering the rate of serious CV incidents febuxostat users seem to have experienced in the US). There is also the matter of the diminishing returns of xanthine oxidase inhibitors. When you have inhibited most of your XO already, what’s the point of taking an even more ridiculous XOI dose?
In my opinion, the reason why Suyash’s uric acid is so high should be investigated. There may be a kidney problem or another serious problem causing this. And while febuxostat may prevent uric acid kidney stones, it will certainly not fix other kidney problems (and it could in theory even cause xanthine stones). There are different drugs for kidney problems, as well as specific dietary recommendations of course (which are different from the dietary recommendations typical gout patients should follow).

[Author]

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